Inside Health

New York, Faulting U.S., Says It Will Pay for Cancer Care for Illegal Immigrants

By SARAH KERSHAW; Winter Miller contributed reporting.

Published: September 26, 2007

CORRECTION APPENDED

Gov. Eliot Spitzer, stepping into a brewing battle between federal and state health officials over emergency medical care for illegal immigrants, called a new federal directive to limit coverage ''morally and clinically and legally wrong'' yesterday and said he was prepared to sue the federal government over it.

Federal health officials have told New York State that they will no longer help cover the cost of chemotherapy for illegal immigrants with cancer because it does not qualify under an emergency Medicaid program. But yesterday, state health officials said they would cover all the costs no matter what the federal government does.

The state health commissioner, Richard F. Daines, who joined Mr. Spitzer yesterday at a news conference in Manhattan, said the state would pay the full cost of chemotherapy for illegal immigrants, estimated at $5 million to $10 million annually.

That announcement, coming after weeks of intense lobbying by advocates for immigrants, marked a reversal of the state's position of only two weeks ago, when state officials said New York could not shoulder the costs itself.

Most illegal immigrants are not entitled to Medicaid coverage, except for emergency care. At the crux of the New York dispute is what constitutes an emergency. The federal government said the New York claims did not qualify because they were part of continuing treatment plans. Other states and Medicaid experts say the Bush administration has been more closely scrutinizing and challenging state spending on health care for illegal immigrants, touching off criticism that bureaucrats, not doctors, are being allowed to make life-or-death medical decisions.

The dispute in New York, home to more than 500,000 illegal immigrants, comes as many states are fighting proposed federal restrictions under the national health insurance program for poor children.

''They are picking on the most vulnerable populations -- here immigrants who need chemotherapy, alternately children who are without health insurance -- and saying to those two groups, 'You will bear the brunt of our new-found fiscal conservatism,' '' Mr. Spitzer said at the news conference, held at Bellevue Hospital Center, which serves a large number of illegal immigrants. ''It is wrong. It's bad policy.''

Officials with the federal Centers for Medicare and Medicaid Services declined to comment yesterday on New York's challenge.

After an audit of New York's Medicaid spending, the centers told the state in August that it should stop filing reimbursement claims for chemotherapy for illegal immigrants.

The State Health Department on Friday sent a letter of protest to federal officials, but has received no response, officials said.

From 2001 to 2006, the federal government denied the state about $11 million in matching funds for the cancer treatment, state officials have said. They have not yet decided whether to try to recoup the money.

Advocates for immigrants praised the governor for taking up the cause.

''He's doing the right thing,'' said Adam Gurvitch, director of health advocacy with the New York Immigration Coalition, which represents more than 150 advocacy organizations.

But critics said that at a time when millions of uninsured American citizens are struggling to pay for health care, the government should not be subsidizing the care of illegal immigrants.

''For every million on chemotherapy for an illegal immigrant, something has to give somewhere,'' said Steven Camarota, director of research at the Center for Immigration Studies, a research group in Washington. ''There's no printing press for money in New York City.''

The crux of the problem, he said, is that large numbers of unskilled immigrants in the country work at low-paying jobs with no health insurance.

Under state law, New York cannot turn away anyone in need of emergency medical care. If a patient is not covered by private or public insurance, hospitals can seek reimbursement from a state fund, but state officials said the $847 million fund is not sufficient.

Correction: October 1, 2007, Monday
An article on Wednesday about New York State's decision to pay the full costs of chemotherapy for illegal immigrants with cancer, despite a federal directive to limit coverage, gave an erroneous figure in some copies for the percentage of New York's Medicaid budget that state officials estimate the treatment costs. It is 0.01 percent to 0.02 percent of the $47 billion budget, not 2 percent.